Octaria Rany, Deppen Stephen, Chan Allison, Slaughter James C, Talley Pamela, Slayton Rachel B, Rebeiro Peter F, Kainer Marion A
Vanderbilt Epidemiology Ph.D. Program, Vanderbilt University Graduate School, Nashville, TN, USA.
Healthcare-Associated Infections and Antimicrobial Resistance Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, TN, USA.
Infect Control Hosp Epidemiol. 2025 Jun 23:1-9. doi: 10.1017/ice.2025.86.
Interfacility patient transfers contribute to the regional spread of multidrug-resistant organisms (MDROs). We evaluated whether transfer patterns of inpatients with similar characteristics to carbapenem-resistant Enterobacterales (CRE) case-patients (CRE surrogates) better reflect hospital-level CRE burden than traditionally used populations.
We determined the risk factors for subsequent hospital admission using demographic and clinical information from Tennessee Department of Health tracked CRE case-patients from July 2015 to September 2019. Risk factors were used to identify CRE surrogates among inpatients in the 2018 Tennessee Hospital Discharge Data System (HDDS). Transfer networks of CRE surrogates, Medicare/TennCare beneficiaries, and all-inpatients with ≤365 days of intervening community stays were compared with the transfer networks of CRE case-patients in 2019. The associations between hospital-level CRE prevalence and hospitals' incoming transfer volumes from each network were assessed using negative binomial regression models.
Eight risk factors for subsequent hospital admission were identified from 2,518 CRE case-patients, which were used to match CRE case-patients with HDDS inpatients, resulting in 10,069 surrogate patients. CRE surrogate network showed more structural similarities with the CRE case-patient network than with the all-inpatient and Medicare/TennCare networks. A 33% increase in hospitals' CRE prevalence in 2019 was associated with each doubling of incoming transfer of CRE surrogates in 2018 (adjusted Risk Ratio [aRR] 1.33, 95%CI: 1.1, 1.59), higher than all-inpatient (aRR 1.27, 95% CI: 1.08, 1.51) and Medicare/TennCare networks (aRR 1.21, 95% CI: 1.02, 1.44).
Surrogate transfer patterns were associated with hospital-level CRE prevalence, highlighting their value in MDRO containment and prevention.
医疗机构间的患者转运促成了多重耐药菌（MDROs）的区域传播。我们评估了具有与耐碳青霉烯类肠杆菌科细菌（CRE）病例患者相似特征的住院患者（CRE替代者）的转运模式，相较于传统使用的人群，是否能更好地反映医院层面的CRE负担。
我们利用田纳西州卫生部2015年7月至2019年9月追踪的CRE病例患者的人口统计学和临床信息，确定后续住院的风险因素。这些风险因素用于在2018年田纳西州医院出院数据系统（HDDS）的住院患者中识别CRE替代者。将CRE替代者、医疗保险/田纳西医疗补助受益人以及社区停留时间≤365天的所有住院患者的转运网络与2019年CRE病例患者的转运网络进行比较。使用负二项回归模型评估医院层面的CRE患病率与各网络中医院的 incoming 转运量之间的关联。
从2518例CRE病例患者中确定了8个后续住院的风险因素，用于将CRE病例患者与HDDS住院患者进行匹配，从而得到10069例替代患者。CRE替代者网络与CRE病例患者网络相比，与所有住院患者和医疗保险/田纳西医疗补助网络相比，显示出更多的结构相似性。2019年医院CRE患病率每增加33%与2018年CRE替代者 incoming 转运量每增加一倍相关（调整风险比[aRR]1.33，95%置信区间：1.1，1.59），高于所有住院患者（aRR 1.27，95%置信区间：1.08，1.51）和医疗保险/田纳西医疗补助网络（aRR 1.21，95%置信区间：1.02，1.44）。
替代转运模式与医院层面的CRE患病率相关，突出了它们在MDRO控制和预防中的价值。
